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Rectal sensory evoked potentials: an Assessment of their clinical value

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Abstract

To assess abnomalities of sensory conduction in anorectal disease we have evaluated peripheral sensory perception and somatosensory evoked potentials produced by rectal stimulation in control subjects and patients with either constipation or idiopathic faecal incontinence. Evoked potentials were also recorded after posterior tibial and dorsal genital nerve stimulation. Rectal sensation was also assessed using electrical stimulation. Reproducible evoked potential recordings after anorectal stimulation were possible in only a minority of subjects and when recorded showed intersubject and intrasubject variation. In the constipated group there was a significant difference in rectal electrical sensation (P<0.05) from controls. We conclude that peripheral sensory testing demonstrates an abnormality in severe constipation. However, cerebral evoked potentials cannot be reliably recorded after rectal stimulation, and when recorded the latencies are of too broad a range to discriminate between health and disease. This probably relates to the difference between somatic and visceral pathways.

Résumé

Pour étudier les anomalies de la conduction sensitive dans les maladies ano-rectales nous avons évalué la perception sensitive périphérique et les potentiels évoqués somesthésiques produits par la stimulation rectale chez des contrôles et des patients avec soit une constipation, soit une incontinence fécale idiopathique. Les potentiels évoqués étaient aussi enregistrés après stimulation du nerf tibial postérieur ou du nerf dorsal génital. La sensation rectale était aussi étudié par stimulation électrique. L'enregistrement reproductible des potentiels évoqués après stimulation ano-rectale était possible chez seulement une minorité de sujets et en cas d'enregistrement montrait des variations entre les sujets et chez un même sujet. Dans le groupe des malades constipés il y avait une différence significative de la sensation rectale électrique (P<0.05) avec les contrôles. Nous concluons que les tests sensitifs périphériques montrent une anomalie chez les malades ayant une constipation sévère. Cependant les potentiels évoqués cérébraux ne peuvent être valablement enregistrés après stimulation rectale et lorsqu'ils sont enregistrés les latences ont un taux de variation trop large pour être discriminatif entre les sujets sains et malades. Ceci est probablement en relation avec la différence entre les voies de conduction somatiques et viscérales.

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Authors and Affiliations

  1. The Sir Alan Parks Physiology Unit, St Mark's Hospital, City Road, EC1V 2PS, London, UK

    C. T. M. Speakman, M. A. Kamm & M. Swash

Authors
  1. C. T. M. Speakman
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  2. M. A. Kamm
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  3. M. Swash
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Additional information

C. T. M. Speakman is supported by the Sir Alan Parks Research Foundation, The Royal College of Surgeons, M. A. Kamm by the St. Mark's Research Foundation

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Speakman, C.T.M., Kamm, M.A. & Swash, M. Rectal sensory evoked potentials: an Assessment of their clinical value. Int J Colorect Dis 8, 23–28 (1993). https://doi.org/10.1007/BF00341272

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